Provider Demographics
NPI:1447762984
Name:WILLIAMS, DANIEL WESLEY (APRN)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:WESLEY
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3810
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-3810
Mailing Address - Country:US
Mailing Address - Phone:417-347-6605
Mailing Address - Fax:
Practice Address - Street 1:322 E 11TH ST
Practice Address - Street 2:
Practice Address - City:BAXTER SPRINGS
Practice Address - State:KS
Practice Address - Zip Code:66713-2605
Practice Address - Country:US
Practice Address - Phone:620-856-2182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017021477363L00000X
KS78052363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner